Implementation of resource use measures in Medicare Advantage

Jeah Jung, Caroline Carlin, Roger Feldman, Linh Tran

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Objective: To complement the previously illustrated method to measure resource use in Medicare Advantage (MA) using Encounter data and provide technical details and SAS code to validate Encounter data and implement resource use measures in MA. Data Sources: 2015–2018 MA Encounter, Medicare Provider Analysis and Review (MedPAR), Healthcare Effectiveness Data and Information System (HEDIS), and Traditional Medicare (TM) claims data. Study Design: Secondary data analysis. Data Collection/Extraction Methods: We select MA contracts with high data completeness (≤10% missing hospital stays in Encounter data and ≤±10% difference in ambulatory and emergency department visits between Encounter and HEDIS data). We randomly sample TM beneficiaries with a similar geographic distribution as MA enrollees in the selected contracts. We develop standardized prices of services using TM payments, and we measure MA resource use for inpatient, outpatient, Part D, and hospice services. Principal Findings: We report identifiers/names of contracts with high data completeness. We provide SAS code to manage Encounter data, develop standardized prices, and measure MA resource use. Conclusions: Greater use and validation of Encounter data can help improve data quality. Our results can be used to inform studies using Encounter data to learn about MA performance.

Original languageEnglish (US)
Pages (from-to)957-962
Number of pages6
JournalHealth services research
Volume57
Issue number4
DOIs
StatePublished - Aug 2022

Bibliographical note

Funding Information:
This study was supported by the National Institute on Aging (NIA) 1R01AG069352‐01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIA.

Publisher Copyright:
© 2022 Health Research and Educational Trust.

Keywords

  • Encounter data
  • Medicare Advantage
  • data validation
  • resource use
  • standardized prices

Fingerprint

Dive into the research topics of 'Implementation of resource use measures in Medicare Advantage'. Together they form a unique fingerprint.

Cite this